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Of the twenty-two cases, twelve recovered and ten died. Of the twelve favorable cases, four ended by lysis and eight by crisis. In the four cases ending by lysis, there was marked leucocytosis at some period of the disease. Before setting in of the lysis, no correspondence between the temperature and leucocyte charts could be noted. In all four cases the two curves began falling together, the leucocytes not reaching normal until one, four and fourteen days after the temperature in case one, two and three respectively. In case there was delayed resolution, and the leucocytosis had not entirely cleared up on discharge.

Of the eight cases ending by crisis, seven showed marked leucocytosis during the febrile period, and in the remaining one the leucocytes remained normal until the temperature fell, but once during recovery the leucocytes reached 13,000. There was no daily correspondence between the two curves in any of these eight cases before crisis. The leucocytes began to fall before the temperature in three cases, with it in two, and after it in three. The fall was only partial in six cases, and they did not reach normal until from two to eight days after the temperature. The leucocytes in the twelve cases ending in recovery ranged from 10,000, the lowest, to 68,000, the highest number noted at any time.

Of the ten fatal cases only one showed a complete absence of leucocytosis during the entire course of the disease. Two cases ranged relatively low, never being above 19,000. In three cases the leucocytes were practically normal on admission, but gradually rose during the ensuing three or four days, touching just before death 30,000, 32,000 and 30,000 respecttively. In two cases they were high on admission, but fell steadily from that time on until death. In one case they were normal for the first two days, but rose sharply to 20,000 24 hours before death, falling slightly just before the end. In one case they behaved as one would expect in an uncomplicated case ending in recovery.

Thus we see that in fatal cases the behavior of the leucocytes varies widely, but that continuous absence is the exception, not the rule.

The following are the conclusions arrived at by the author from his study of these twenty-two cases:

"1. In cases of pneumonia pursuing a favorable course there is, as a rule, a marked increase in the number of the leucocytes during the febrile period of the disease. This leucocytosis is probably present at the time of the chill, and may be very marked within a few hours. There is no correspondence between the daily temperature and leucocyte curves during the febrile period."

"2. In those cases in which the temperature curve falls by crisis, the leucocyte curve begins to fall within a few hours of the same time. The

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fall of the latter is only partial, however, and rarely reaches normal as soon as the temperature curve, generally taking about 48 hours longer. In cases ending by lysis the two curves fall together, the temperature always reaching normal first. In cases of delayed resolution the leucocytes may remain elevated for days."

"3. In a majority of the cases the leucocyte curve rises during the period of full temperature, and may, reach its maximum at that time. Such a rise is only transient, however, and is soon followed by a fresh fall."

"4. In cases showing extensive involvement of both lungs, the leucocytes are apt to reach a higher point than in those cases where the involvement is only moderate. The correspondence of lung involvement and amount of leucocytosis is a very rough one, however."

"5. The fatal cases may show either the presence or absence of leucocytosis. In those cases showing a leucocytosis, some other cause of death than the virulence of the bacterial poison must be sought for."

"6. The prognosis in cases showing a complete and continuous absence of leucocytosis is unfavorable, as a rule. A continuous absence of leucocytosis is the exception, most cases showing a leucocytosis at some period of the disease. The possibility of the absence of leucocytosis being due to extreme mildness of the disease must not be overlooked."

"7. The leucocytosis in pneumonia is a so-called pure leucocytosis, i. e., an increase in the polynuclear elements solely. In cases showing no leucocytosis, the blood condition according to the observations here reported, is normal. Further investigations are necessary before the work of previous observers can be positively contradicted."

"8. The presence or absence of leucocytosis only shows the virulence of the bacterial poison. It is not a criterion of absolute prognosis."

A NEW CULTURE-MEDIUM FOR THE BACILLUS OF DIPHTHERIA AND

OTHER BACTERIA.

Ball (Medical News, November 24, 1894) has demonstrated that ordinary coagulated blood forms a suitable and easily prepared medium upon which to grow the Klebs-Loeffler bacillus for diagnostic purposes. For diphtheria a transparent medium is not a necessity. The grayish-white colonies are plainly visible on a dark background.

In his own words, Ball prepares what he terms "nutrient blood-coagulum" as follows: "The blood of an animal is collected in a sterilized jar or bottle. As soon afterwards as possible, small sterilized glass test-tubes are filled one-quarter full of the pure blood, before it has clotted, or of the colored fluid portion which has separated if clotting has already begun. The tubes are then placed in a slanting position (a small tin box can easily

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be constructed for this purpose, or improvised so that the tubes will lie nearly horizontal) in a water-bath, and slowly heated until the water in the bath is boiling; the boiling should be continued for ten minutes or more, until the blood has coagulated and become solid. It then has a chocolate color and a moist-appearing surface, upon which a stroke-culture can be made. If the tubes are to be kept for any length of time they can be sterilized two or three times at a temperature of 85° C. without injuring the medium."

As the diphtheria germ grows best at the temperature of the body, this writer suggests that in the absence of laboratory apparatus, the inoculated tubes might be enclosed in a small box, so as to prevent breakage, and worn in the night-shirt pocket of the patient, or the inside vest-pocket of the physician, until development occurs. Diphtheria was diagnosticated after ten hours on the coagulated blood. The author thinks that this method could be applied to pathogenic germs other than those of diphtheria, such as the bacillus tuberculosis, etc.

The advantages set forth for nutrient blood-coagulum are its ease and rapidity of preparation. It can be prepared with only such apparatus as is always at hand, and the dark color of the culture soil brings the light-colored colonies into strong relief, thereby allowing of early diagnosis.

THE PATHOGENIC MICROBE OF THE BUBONIC PLAGUE.

According to the St. Louis Medical and Surgical Journal (February, 1895, p. 99), the French government dispatched Surgeon Yersin to Hong-Kong, China, to determine the specific cause of the epidemic raging in that country, known as the "bubonic plague."

Yersin arrived in Hong-Kong about June 15, 1894, and the day previously Kitasato arrived in the same city upon a like mission. Each inves tigator went to work separately and independently of the other, and in about the same space of time-three weeks-independently isolated the causative germ of the disease.

This phase of the work beautifully illustrates the perfection of bacteriologic tecnique, as these men carried on their investigations without the knowledge of the presence of the other, and arrived at identically the same. results in about the same length of time.

Both of these observers found the specific organism to reside in the blood itself; and where the malady is well advanced it is necessary to with draw only a drop of blood from the finger-tip in order to demonstrate the germ. At the outset of the disease it may be necessary to examine several specimens before one will be encountered containing the infecting microbe. This same germ was also found in the enlarged lymphatic glands, the

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"bubonic swellings," which are a necessary accompaniment of this disease, the enlarged glands are said to be filled with a substance of a "mush-like" consistency, which latter, on examination, was shown to be made up of almost pure cultures of the organism. Examinations made of individuals having died from this affection "revealed the presence of the pathogenic microbe in the blood of the heart, in the lungs, liver, spleen, brain and intestines."

Both investigators found the bacillus to be easily cultivated artificially on bouillon and glycerin-gelatin at the body temperature in the incubator; the ordinary technique for such work being utilized. Tubes thus inoculated were at the end of twenty-four hours found to be "teeming with the specific micro-organisms."

The artificial cultures injected into mice, rats, guinea-pigs and rabbits caused death in from two to five days, death being preceded by the ordinary phenomena of the bubonic plague. The lesions produced in these animals are said to be nearly identical with those found in animals dead of anthrax.

These physicians conclude that the "free infecting microbe makes its habitat in the soil, like those of anthrax and cholera, and that the disease is transmissible by the inhalation or absorption of dust, refuse, etc., either alone or in articles of alimentation. A guinea-pig fed with food in which the sweepings of an infected house were mixed had every symptom and lesion of the plague. The bacillus was detected by both physicians in the internal organs of rats and mice found dead in the same house."

The fact had long ago been noted by the resident physicians of China, that "flies swarming around the cadaver of plague-stricken animals died in great numbers,"

Dr. Yersin isolated the bacillus from a specimen of earth taken from the soil under an infected Chinese house.

From their investigations, Yersin and Kitasato conclude that, at least in China, flies, rats and mice are the most frequent carriers of the bacillus causative of the bubonic plague, and that its probable natural habitat is the soil.

A New Cure for Insanity.-Professor Wagner, of Vienna University, expounded a cure for insanity to the Medical Society, February 23, 1895. He injected Koch's tuberculine, causing a fever, after which the insanity diminished. He repeated the treatment a few times, each injection lessening the insanity until eventually it vanished.

Oil of Cinnamon, citric acid, eucalyptus, peppermint oil, and a few other drugs comprise all the germicides the profession can depend on. Such is the dictum of the Pasteurine Institute and the Municipal Laboratory, Paris, as well as of Sternberg's great work on bacteriology. These agents are now combined in most efficacious form in the name Pasteurine, prepared in both liquid and tablet form.

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SURGICAL PROGRESS.

BY EMORY LANPHEAR, M. D., PH. D., ST. LOUIS, MO.

Surgery of the Pericardium.-Some time age when I reported aspiration of the pericardium and withdrawal of the accumulated fluid, in a case of hydro-pericardium in which the heart's action was labored, I was criticised as "too bold" and "too aggressive." Recently, however, a number of operators have made the pericardium the subject of operative procedures. One of the most remarkable cases yet reported is that of Dr. H. C. Dalton, of this city. The history is that a man 22 years of age, received a stab in the chest 11⁄2 inches above the left nipple. Heart dullness was normal, and there was no dullness on percussion of chest. Ten hours after the temperature was 101 F., pulse 112, and respiration 40. Percussion now gave dullness over the entire left side. Respiration was superficial and the pain considerable. The dressing was removed, when blood and air gushed from the wound with each respiration. An incision was made over the fourth rib, and 6 inches of it excised and much fluid and clotted blood cleared out of the pleural cavity. A transverse wound of the pericardium, 2 inches in length, was now revealed. No wound of the heart could be discovered. The pericardial wound was with very great difficulty, closed by continuous suture, and the patient made an uninterrupted recovery in spite of having been apparently moribund several times during the operation. In stab wounds of the thorax, the rule of non-interference without grave symptoms, would not hold good if such injuries be low down, for here we may have injury to the diaphragm or abdominal viscera, often without grave symptoms. In this case there were no dyspnea, cough, or increased cardiac dullness. Hemorrhage came on several hours after the injury, and then temperature, pulse, and respiration were all increased. The closing of the pericardial wound was done to prevent infection from the pleural cavity, and to avoid adhesions to heart wall or pulmonary pleura, and the result seems to justify the rather difficult and prolonged manipulation.

The Murphy Button for Circular Enterorrhaphy.-Until the introduction of the Murphy button into intestinal surgery, end to end anastomosis was regarded as one of the most dangerous operations practiced. Now, however, successful cases are becoming quite common, but are still noteworthy. The latest report of recovery is that of Dr. W. Mitchell Banks, Surgeon to the Royal Infirmary of Liverpool, England, British Medical Journal, February 23, 1895. From the patient, a boy of 7 years, he removed several inches of bowel, gangrenous from intussusception, and made circular enterorrhaphy, with perfect recovery. In commenting upon the case, Dr. Mitchell very aptly says that in abdominal surgery two great factors make for success - maintenance of an absolutely aseptic condition of the peritoneum and rapidity in the actual performance of the operation; the button greatly facilitating the latter requirement. The Murphy button has been in use about two years and a half in America, and in a paper published